Piles (Haemorrhoids). Miss Rina George answers the FAQ’s....
Miss Rina George, Consultant General & Colorectal Surgeon
Claremont Clinics: Saturday mornings
What are piles?
Absolutely everyone has anal cushions in their back passage. These cushions are there to help you decide if you are going to pass wind or a motion, and help control things until you are in a convenient place to open your bowels. These anal cushions have blood vessels in them, which can become swollen or engorged, causing pain. They can also become fragile, causing bleeding.
When these anal cushions cause a problem, they are called piles or haemorrhoids. Haemorrhoids can be external, where they come out of the anal canal, or internal, where you may not notice anything on the outside of your bottom.
What symptoms can you get with piles?
The commonest problem is that piles can bleed and sometimes this can seem quite dramatic. It is usually bright red blood, like if you had cut yourself and can be on the toilet paper when you wipe, or in the toilet bowl after passing a motion. It is usually painless. They can also cause itching around the anus or a mucous discharge, which can feel like you a leaking motion from your back passage, without any control.
When the piles prolapse out of your back passage (anus), they can then get engorged and uncomfortable. Sometimes a blood clot can develop in them, called a thrombosed pile, and this can be very painful.
What should I do if I think I have piles?
The first point to make clear is that piles do not become anything sinister or cancerous if left alone. However, when you have problems as described above, they can also be symptoms of something more serious like a bowel or anal cancer. You could also have inflammation of your bowel called colitis, which does need medical treatment.
It is recommended that you seek medical advice from your GP or a specialist, to make sure there are no sinister causes for your symptoms and to start treatment, should it be needed.
What happens when I see a specialist for piles?
A doctor will ask you about your symptoms and medical history. You will then have an examination of your tummy and back passage which does not need you to have your bowels cleared out first.
In most cases, we would organise a formal camera test (flexible sigmoidoscopy or colonoscopy) to look further into your bowel to make sure we are not missing any other diagnosis. It does involve having your bowels cleared out with an enema or a preparation taken by mouth, so we can see the inside of your bowel clearly. If the camera test shows that you have piles and no other problem, the specialist would then advise you on treatment.
What treatments are there for piles?
If your tests are normal and your symptoms have eased, you don’t need to do anything further. If your symptoms are mild, for example, occasional bleeding that’s on the paper when you wipe, this often responds to increasing your fibre and water intake. This softens your motion so that it is easy to pass and can prevent you from straining. Taking a regular laxative can also be helpful.
If you have internal piles with itching, mucous discharge or bleeding, we would recommend banding your piles. This can be done in clinic or when you have your camera test and you would normally be able to resume normal activity straight afterwards.
When internal piles do not respond to changes in diet or banding, I would perform a Haemorrhoidal Artery Ligation Operation (HALO). This stitches the main blood vessels that supply the piles and is done while you are asleep under a general anaesthetic. We would usually perform this as a day case procedure, where you would be back at home on the day of surgery.
For the external piles that prolapse out of the anus, we would perform an operation where we remove the most prominent piles. This is called an open haemorrhoidectomy and again, is carried out under a general anaesthetic as a day case procedure. For both the HALO procedure and the open haemorrhoidectomy, you would be expected to have some time off work to recover.
If you're worried, Miss George will be happy to see you at Claremont.
A private consultation with Miss George at Claremont costs £150 if you don't have health insurance. For more information or to book an appointment with Miss George, call our Private Patient Team on 0114 263 2114. You will need a referral letter from your GP or you can see one of our Private GPs quickly for this if you prefer.
Copyright Rina George, 2017.